Chapter 30- Spirituality

23. During an assessment an older male patient states that he has not been happy in life because he does not deserve to be loved. The nurse realizes that this patient believes love has been withheld because of which criteria? (Select all that apply.) A) Productivity B) Social position C) Education level D) Physical condition E) Material possessions

Ans: A, B, D, E Feedback: Spiritual love is unconditional and people need to feel loved regardless of their physical condition, social position, material possessions, or productivity. Educational level is not identified as a condition for being loved.

24. The nurse determines that a patient is experiencing spiritual distress. What did the nurse assess in this patient? (Select all that apply.) A) Anger B) Smiling C) Complaining D) Poor appetite E) Refusing to make plans

Ans: A, C, D, E Feedback: Signs of spiritual distress include anger, complaining, poor appetite, and refusing to make plans. Smiling would not be a sign of spiritual distress.

14. During an interview process as a staff nurse for a geriatric patient care area, the nurse is asked about her philosophy of spirituality. Why is this important when caring for older patients? A) Spirituality becomes more unconditional as people age B) Spirituality often becomes more important to people as they age C) An individual's spirituality remains stable from youth through old age D) As people age, their spirituality becomes more quantitative than qualitative

Ans: B Feedback: All humans have spiritual needs, regardless of whether they realize or acknowledge them. Some of these needs become particularly relevant in late life when the high prevalence of chronic illness and reality of death are evident. Spirituality does not become more unconditional as people age. Spirituality may change throughout the life. There is no evidence to support that spirituality becomes more quantitative than qualitative as people age.

22. A patient is demonstrating signs of spiritual distress but refuses to be visited by clergy or to participate in religious services. What should the nurse do to help the patient? A) Arrange for a volunteer to read inspirational essays to the patient B) Do not challenge the patient's decision or attempt to change his mind C) Pray that the patient will come to recognize his need for spiritual support D) Talk with the hospital chaplain about looking in on the patient without talking about religion

Ans: B Feedback: Although a nurse should assist patients in their spiritual growth, the nurse's first commitment is to respect patients' wishes. A nurse should not challenge a patient's religious beliefs or attempt to change them. The nurse should not have inspirational essays read to the patient or talk with the hospital chaplain. The nurse may or may not want to pray about the patient's needs for spiritual support.

6. An older patient just learning of having a terminal illness begins to cry. Which statement or question should the nurse make to facilitate the patient's spiritual health? A) "Remember that everything in life, even the bad things, happens for a reason." B) "Is there anything in your spiritual beliefs or practices that might bring you comfort at this time?" C) "It's not appropriate for me to pray with you, but would you like me to arrange a visit from the chaplain?" D) "It's likely best for you to try to focus on what is going right in your life, even though that's likely hard right now."

Ans: B Feedback: Asking the patient how spiritual needs can be supported is a recognized component of spiritual assessment and acknowledges the patient's spiritual needs while still letting the patient direct the process. Making off-hand statements such as things happening for a reason and encouraging the patient to focus on the good things in life would be inappropriate at this time. It is not inappropriate for a nurse to pray with a patient when circumstances allow.

25. A patient tells the nurse that she has practiced meditation for years since it has helped her with mental clarity. Which type of meditation should the nurse document that the patient practices? A) Mindfulness B) Concentrative C) Transcendental D) Trans-mutational

Ans: B Feedback: Concentrative meditation calms the person and promotes mental clarity and acuity. Mindfulness meditation promotes a calm nonreactive mental state. Transcendental meditation relaxes the body while keeping the mind alert. Trans-mutational is not a type of meditation.

21. An older female patient tells the nurse that through periods of trial and tribulation, the Bible has been the source of ongoing strength and support. Which statement supports this patient's beliefs by researched evidence? A) Patients from low socioeconomic levels tend to be more religious. B) Religious commitment has a positive effect on health care outcomes. C) Patients holding strong religious convictions experience great emotional stress during illness. D) Among the elderly, high levels of religiosity correlate with greater levels of physical disability.

Ans: B Feedback: Evidence suggests that strong spiritual beliefs facilitate health and healing; therefore, it is therapeutically beneficial to support patients' spirituality and assist them in fulfilling spiritual needs. The other statements are not supported by researched evidence.

2. The nurse manager of a geriatric medicine unit learns that spiritual care services are underutilized by patients and their families. Which phenomenon explains this finding? A) While spiritual needs are a universal part of the human condition, many people do not acknowledge these needs. B) The high-stress environment of a hospital is incompatible with the solace and quiet necessary for addressing spiritual needs. C) Spiritual needs are less apparent during times of immediate and tangible need, such as acute illness requiring hospital treatment. D) Many older adults who have experienced a lifetime of self-sufficiency and practical resourcefulness do not have spiritual needs.

Ans: A Feedback: All humans have spiritual needs regardless of whether they realize or acknowledge them. Some of these needs become relevant in late life when the high prevalence of chronic illness and the reality of death are evident. While a hospital does provide a high-stress environment, this is not mutually exclusive with identifying and providing for patients' spiritual needs.

16. The nurse is preparing a list of patients who will need the annual influenza inoculation. Which older adult will most likely refuse this vaccination? A) A 71-year-old Christian Scientist B) A 68-year-old man who attends a Unitarian church C) A 68-year-old female patient who identifies herself on admission as a Jehovah's Witness D) A 78-year-old who says that she is a member of the Church of Jesus Christ of Latter Day Saints

Ans: A Feedback: Christian Science is a religion based on the use of faith for healing. Christian Scientists may decline drugs, psychotherapy, hypnotism, vaccination, and some other treatments. The other religions and beliefs do not specify that vaccinations are to be avoided.

12. At the conclusion of a health history the nurse conducts a spiritual assessment with the patient. Why is this assessment important? A) Strong spiritual beliefs facilitate health and healing B) A spiritual crisis can trigger a psychosomatic disease C) It is the nurse's job to facilitate communication between the patient and the clergy D) The nurse needs to be careful that therapeutic regimens do not violate a patient's religious beliefs

Ans: A Feedback: Evidence suggests that strong spiritual beliefs facilitate health and healing; therefore, it is of therapeutic benefit to support patients' spirituality and assist them in fulfilling spiritual needs. The nurse does not complete a spiritual assessment to avoid the onset of a psychosomatic disease or to facilitate communication between the patient and the clergy. This assessment is also not being done to ensure that therapeutic regimens will not violate the patient's religious beliefs.

27. A patient is observed sitting on the side of the bed crying. When approached the patient does not say anything but continues to cry and hold the nurse's hand. What should the nurse do to communicate being present with the patient? A) Sit down next to the patient B) Leave the patient alone to cry C) Encourage the patient to stop crying D) Ask the patient to use the call bell if he or she wants to talk

Ans: A Feedback: Nurses need to be available for patients to express their feelings. This means being fully present without being distracted or thinking about other activities. The best action for the nurse to take to communicate being present with the patient is to sit down next to the patient. Leaving the patient alone to cry, encouraging the patient to stop crying, or asking the patient to use the call bell if he or she wants to talk does not communicate being present with the patient.

13. A patient with cancer asks the nurse to pray with him but the nurse does not feel comfortable with prayer. What should the nurse do? A) Decline politely and ask a coworker to pray with the patient B) Arrange transportation so that the patient can attend prayer meetings at his church C) Pray with the patient after making sure he understands that the nurse would prefer not to D) Pray with the patient realizing that the patient's needs are more important than the nurse's beliefs

Ans: A Feedback: People of faith have long understood the value of prayer, and now growing research evidence supports the positive relationship between prayer and health and healing. One need not be an ordained clergy to hold a patient's hand and offer a prayer. Nurses who are not comfortable offering prayers themselves can ask coworkers to pray with and for their patients who so desire.

20. An older patient tells the nurse that he meditates to seek enlightenment. Because of this, the nurse might inquire if he wishes to have which item eliminated from his daily dietary intake? A) Beef B) Cereal C) Refined sugar D) Leavened bread

Ans: A Feedback: The belief that enlightenment is found in individual meditation is a characteristic of Buddhism. Buddhists often are vegetarians. Cereal, refined sugar, and leavened bread are not specifically identified as being omitted from the diet of a person who practices Buddhism.

8. An older male patient with end-stage renal disease is sad and believes that he will die within a few days. Which interventions should the nurse use to promote hope in the patient? (Select all that apply.) A) Using humor at the bedside B) Facilitating a life review for the client C) Helping the client to find pleasure during current life activities D) Encouraging the client to focus on a time of life that was more pleasant E) Introducing the client to an individual who has a much poorer prognosis and/or health status

Ans: A, B, C Feedback: The tactful use of humor, facilitation of life review, and aiding clients in finding pleasure in activities are noted to instill hope. Encouraging comparison to someone with a worse situation and encouraging focus on a different time of life are not noted to foster the development of hope.

26. The nurse is planning care to address a patient's spiritual distress. Which interventions would be appropriate to include in this plan of care? (Select all that apply.) A) Pray with the patient upon request as needed and desired B) Find a volunteer to read the Bible to the patient upon request C) Remind the patient that spiritual needs are often addressed last D) Contact the patient's church to have the clergy visit the patient E) Help the patient identify factors contributing to spiritual distress

Ans: A, B, D, E Feedback: Interventions to address spiritual distress include praying with the patient upon request and as desired, finding someone to read the Bible to the patient upon request, contacting the patient's church for clergy to visit, and helping the patient identify factors that contribute to spiritual distress. Reminding the patient that spiritual needs are often addressed last will not help with the patient's spiritual needs at this time and would be inappropriate to include in the plan of care.

15. Which statement should the nurse use to plan interventions to address the behavior of an older patient sitting quietly alone in a room? A) Spending a lot of time alone is a sign that an elder is lonely or grieving. B) Uninterrupted periods of solitude and inactivity are therapeutic for the elderly. C) Solitude should be discouraged among elders because it leads to social isolation. D) Occupational therapy should be arranged for an elder often observed doing nothing.

Ans: B Feedback: Periods of solitude are therapeutic to the elderly. Unresolved feelings from earlier years may be contemplated and resolved, resulting in personal satisfaction. In reminiscing, evaluating, and understanding the dynamics of life's earlier events and achievements, older persons can find a satisfaction with the quality of their lives that helps compensate for their multiple losses. Spending time alone is not a sign that the patient is lonely or grieving. Solitude does not lead to social isolation. Activities should not be planned for an older patient who is doing nothing.

10. An older male patient admits to doing many things in life that he is not proud of and is having a difficult time getting them out of his mind. How should the nurse respond to the patient's statement? A) "Remember that no one has lived a perfect life." B) "Is there anyone that you might want to ask forgiveness from?" C) "Is there anything I can do to help you focus on more positive things?" D) "Do you think that you were really any worse than most other people?"

Ans: B Feedback: Seeking forgiveness can be a powerful tool in attaining spiritual health. Urging comparison to others is inappropriate and attempting to change the patient's focus to more positive subjects is not an appropriate intervention.

1. An older female patient tells the nurse that even though she believes in a higher power she is not interested in information on the hospital's chaplaincy services since she has never been religious. What does the nurse recognize as the relationship between religion and spirituality? A) Some people are religious, while others are spiritual. B) Religion is a particular, structured way of expressing spirituality. C) Religion is the essence of our being that connects us with the Divine. D) All human beings have an innate desire for religious structure and spiritual fulfillment.

Ans: B Feedback: Spirituality differs from religion, which consists of human-created structures, rituals, symbolism, and rules for relating to the Divine. Religion is a significant expression of spirituality, but highly spiritual individuals may not identify with a specific religion. Not everyone identifies a need for religion, and religion and spirituality are not mutually exclusive. Spirituality, not religion, is defined as the essence of our being that connects us with the divine.

19. An older female patient in the resident care facility insists that her hair be kept covered at all times. Of which branch of the Jewish faith is she most likely a member? A) Reform B) Orthodox C) Rabbinical D) Conservative

Ans: B Feedback: The covering of the hair of married women is a practice of Orthodox (observant) Judaism. Those who practice Conservative Judaism cover the head during worship and prayer. Those who practice Reform Judaism do not follow laws for covering the head. There is no branch of Rabbinical Judaism.

4. The nurse is caring for older patients in a long-term care facility. When ensuring for these patients' dignity, which statement reflects the role of dignity as it relates to the spiritual needs of the older adult? A) Older adults who have lived a life of integrity and service have earned dignity. B) An acknowledgment of spiritual needs is necessary for the presence of dignity. C) Older adults may lack many of the attributes that are valued in society, but they can derive a sense of dignity from spirituality. D) Older adults who have moved successfully through Erikson's stages of development can experience dignity in spite of disability.

Ans: C Feedback: Despite declines in such areas as productivity and physical appearance, older adults can maintain a sense of their intrinsic worth, or dignity, by connecting with the Divine. Acknowledgment of spiritual needs is not necessarily a prerequisite for dignity, given that dignity is by definition inherent in all persons, nor is progression through Erikson's stages or a life of service necessarily required.

9. An older female patient, experiencing cancer pain and nausea and vomiting from chemotherapy, asks the nurse to pray for her during this difficult time. How should the nurse respond to the patient's request? A) Facilitate a visit from a chaplain to the client at the bedside. B) First determine whether the client shares a similar religious tradition as the nurse. C) Pray for the client, asking a higher power to intervene and provide peace and relief. D) Explain that praying is beyond the nurse's scope of practice and explore alternative interventions.

Ans: C Feedback: Nurses are justified in praying for clients and can simply ask a higher power to intervene. An identical religious tradition is not a prerequisite and praying need not be delegated to a chaplain. Praying is not beyond the nurse's scope of practice.

5. The spouse of a patient with dementia remains upbeat and is appreciative of having good health and a loving family. The nurse realizes that the spouse is demonstrating which component of spirituality? A) Hope B) Fatalism C) Gratitude D) Transcendence

Ans: C Feedback: Gratitude is characterized by a sense of thankfulness and positivity, as exemplified by the woman's focus on what she has rather that what she lacks. Transcendence involves an awareness of a reality beyond oneself and hope is an expectation that looks to the future. Fatalism is a resignation to the inevitability of life events.

3. The nurse is aware of the spiritual dimension in Erikson's conceptualization of the older adult's growth and development. When applying Erikson's theory to the care of older patients, what does the nurse realize as being a spiritual component of Erikson's final development task? A) Awareness that one is loved by others and has provided unconditional love. B) A confidently held hope that a transcendent and positive afterlife awaits one following death. C) A sense of contribution that one's relationships and endeavors have benefited society and one's family. D) A sense of wholeness rooted in the knowledge that life experiences make sense and have served a purpose.

Ans: D Feedback: According to Erikson's description of the final developmental task, healthy psychological aging for the older adult involves achieving a sense of integrity. This integrity, or wholeness, is supported by the belief that life experiences—both good and bad—make sense and have served a purpose. The other choices express needs that older individuals may possess, but these are not components of Erikson's framework.

11. Two nurses are discussing the relationship between spirituality and religion. Which statement explains this relationship? A) They are the same. Both connect individuals to the Divine and to other living things. B) They are directly related. The more spiritual the individual, the greater his or her commitment to religion. C) They interact inversely. Heavy involvement in organized religion diminishes spirituality and vice versa. D) They are different. Spirituality is a sense of connection to the Divine; religion is a structure of beliefs, rituals, and rules.

Ans: D Feedback: Spirituality is the essence of our being that transcends and connects us to the Divine and other living organisms. It involves relationships and feelings. Spirituality differs from religion, which consists of human-created structures, rituals, symbolism, and rules for relating to the Divine. Religion is a significant expression of spirituality, but highly spiritual individuals may not identify with a specific religion.

18. The nurse is caring for an older patient who is nearing death and realizes that no professional clergy needs to be contacted. This patient is most likely a member of which faith? A) Pentecostal B) Unitarianism C) Seventh-Day Adventists D) Church of Jesus Christ of Latter Day Saints

Ans: D Feedback: The Church of Jesus Christ of Latter Day Saints (Mormons) is the only faith of those listed that has no professional clergy.

7. What should the nurse use to help guide interventions to meet the spiritual needs of a patient? A) The client's prognosis for recovery B) The nurse's own religious tradition C) The denominational affiliation of the chaplain D) The presence of icons and religious books at the bedside

Ans: D Feedback: The presence and identity of a patient's religious books and symbols can be useful insights into a patient's spiritual belief system. This information would supersede the religious affiliation or tradition of the nurse or chaplain as well as the patient's objective prognosis for recovery.

17. For patients from which of the religious groups would an opportunity to fast in the weeks before Easter be most important? A) Jewish B) Eastern Orthodox C) Seventh-Day Adventist D) Episcopalian (Anglican) Ans: B

Feedback: Fasting during Lent is practiced by members of the Roman Catholic and Eastern Orthodox churches. Fasting is not typically done prior to Easter by those of the Jewish, Seventh-Day Adventist, or Anglican Episcopalian faiths.